Documente Academic
Documente Profesional
Documente Cultură
SRL
Loc______________Jud____________
Locul predarii_______________________Data___/___/______
Predatator
Nume/Prenume________________________domiciliat in ________________________
str._________________ nr.______ Jud._______________ posesor al BI/CI cu Seria________
nr.______________ cu functia de _________________
PRIMITOR:
Nume/Prenume________________________domiciliat in ________________________
str._________________ nr.______ Jud._______________ posesor al BI/CI cu Seria________
nr.______________ cu functia de _________________
Stare de functionare___________________;
Pag. 1 din 5
Defectiuni constatate :
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Documente:
Nr.crt Denumire document Observatii
1. Certificat de inmatriculare autovehicul
16.
Pag. 2 din 5
17.
18.
19.
20.
Accesorii:
Nr.Crt Denumire Numar Unitate masura(buc, set,etc.)
1. Stingator
2. Trusa medicala
3. Triunghi reflectorizant
4. Vesta reflectorizanta
5. Trusa de scule
7. Roata de rezerva
8. Cric
15. Becuri
18. Statie
Pag. 3 din 5
19. Antena
28. Casca
29. Bocanci
30.
31.
32.
33.
34.
35.
Primitorul a preluat autovehiculul in dotare cu cele amintite mai sus, in urma unui inventar,
fiind raspunzator de lipsa oricaruia dintre cele amintite, precum si de defectiunile cauzate de
Observatii:
______________________________________________________________________________
Pag. 4 din 5
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
AM PREDAT AM PRELUAT
Nume/Prenume Nume/Prenume
____________________________ ________________________________
Semnatura Semnatura
______________________________ ______________________________
Prezentul formular a fost incheiat intr-un nr. de____________exemplare, din care ____________
ramane la predator si_____________ la primitor
Pag. 5 din 5